Cranioplasty complications

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• Iatrogenic Cranial Pseudomeningocele on the Stroke Unit: A Lesser-Known Potential Complication After Decompressive Hemicraniectomy Following Malignant Middle Cerebral Artery Syndrome
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• Optimizing Strategies in Patients Affected by Tumors Infiltrating the Skull: A Single Center Experience
• Cranioplasty Approaches and Outcomes in Low-Middle Income Countries: A Systematic Review
• Integrated Clinical Genetic Analysis of Meningiomas Causing Bony Hyperostosis Shows More Severe Clinical Course and Overexpression of Secreted Pro-osteogenic Factors
• Exploring Gorham-Strout syndrome in a young adult: an illustrative case report and literature review

Complications include:

a) infection:≈8% risk

b) hematoma: under the cranioplasty flap (epidural or subdural). Epidural more likely than subdural

c) seizures

d) brain injury

e) Autologous bone flap cranioplasty complications

f) hydrocephalus

g) CSF leak

h) Temporal hollowing

The risk of complication is increased with bifrontal bone defects.

The incidence of complications after cranioplasty is high, ranging from 12% to 50%.

The complication rate of cranioplasty is higher than for other elective neurosurgical procedures. Older age, poorer functional situation (worse Barthel index score) and early surgery (≤85 days) are independent risk factors for complications ¹⁾.

Cranioplasty after decompressive craniectomy (DC) is associated with increased morbidity, but the reported mortality rate is low.

Intracranial pressure (ICP) is a crucial factor that we need to take into account in all major pathophysiological changes of the brain after decompressive craniectomy (DC) and cranioplasty (CP). The purpose of a study was to check ICP values before and after cranioplasty and its relation to various parameters (imaging, demographics, time of cranioplasty, and type of graft) as well as its possible relation to postsurgical cranioplasty complications. The authors performed a prospective study in which they selected as participants adults who had undergone unilateral frontotemporoparietal DC and were planned to have cranioplasty. Intracranial pressure was measured with fiber-optic sensor in the epidural space and did not affect cranioplasty in any way.Twenty-five patients met the criteria. The mean vcICP (value change of ICP) was 1.2 mm Hg, the mean ΔICP (absolute value change of the ICP) was 2.24 mm Hg and in the majority of cases there was an increase in ICP. The authors found 3 statistically significant correlations: between gender and ΔICP, Δtime (time between DC and CP) and vcICP, and pre-ICP and ±ICP (quantitative change of the ICP).Μale patients tend to develop larger changes of ICP values during CP. As the time between the 2 procedures (DC and CP) gets longer, the vcICP is decreased. However, after certain time it shows a tendency to remain around zero. Lower pre-ICP values (close to or below zero) are more possible to increase after bone flap placement. It seems that the brain tends to restore its pre-DC conditions after CP by taking near-to-normal ICP values ²⁾.

Epidural Fluid Collection.

The Death from brain herniation after cranioplasty ³⁾

Brain edema after cranioplasty.

Cranioplasty-related reperfusion injury ⁴⁾

see Cranioplasty infection.

see Epilepsy after cranioplasty.

see Autologous bone flap cranioplasty complications.

Male, 47 years old, with a history of malignant middle cerebral artery infarction with decompressive craniectomy exactly one year ago and underwent cranioplasty

Reports experiencing an unusual headache and swelling with increased temperature in the cranioplasty area, along with the discharge of serosanguinous fluid that was not present before.

Physical Examination (EF): Swelling in the cranioplasty area with increased temperature.

An urgent non-contrast and contrast-enhanced cranial CT scan is performed.

REPORT: Compared to the last study there is a presence of an extra-axial collection on the right convexity underlying the cranioplasty. It has a subdural morphology, approximately 2.7 cm in the coronal plane, with a heterogeneous content predominantly hyperdense, likely related to hematic residues, as well as some minimal air bubbles. There is a striking enhancement of the dura mater, and radiological signs suggestive of subdural empyema. This collection causes a mass effect on the underlying cerebral sulci but does not cause midline deviation or clear signs of herniation.

A discrete increase in extracranial soft tissues of about 2 cm thickness in the coronal plane adjacent to the cranioplasty is also identified. It shows heterogeneous contrast enhancement and ill-defined hypodense foci inside, suggesting soft tissue infection with associated myositis and subgaleal collections.

There are no signs of bone resorption of the cranioplasty suggesting associated osteomyelitis.

Extensive corticosubcortical hypodensity in the territory of the right middle cerebral artery is identified, indicating an old ischemic infarction. This results in slight retraction of the right occipital and temporal horns, as well as slight hypodensity of the right mesencephalic peduncle related to Wallerian degeneration.

Cranioplasty complications case series.